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What screening approach could improve early detection of ‘at-risk’ metabolic dysfunction–associated steatohepatitis in my patients?

Zehra Naseem, MD, Yael Mauer, MD, MPH and Sobia Laique, MD
Cleveland Clinic Journal of Medicine July 2026, 93 (7) 397-401; DOI: https://doi.org/10.3949/ccjm.93a.26013

Article Figures & Data

Figures

  • Natural progression of metabolic dysfunction–associated steatotic liver disease and clinical outcomes. Fibrosis stages F2 and F3 are considered “at-risk” metabolic dysfunction–associated steatohepatitis (MASH). Patients with metabolic dysfunction–associated steatotic liver (MASL) progress by 1 fibrosis stage approximately every 7 years, but 22% of patients can progress quickly to cirrhosis in 2 years.3,4 Early intervention can prevent fibrosis progression and induce regression.Based on references 3–6.
    Figure 1

    Natural progression of metabolic dysfunction–associated steatotic liver disease and clinical outcomes. Fibrosis stages F2 and F3 are considered “at-risk” metabolic dysfunction–associated steatohepatitis (MASH). Patients with metabolic dysfunction–associated steatotic liver (MASL) progress by 1 fibrosis stage approximately every 7 years, but 22% of patients can progress quickly to cirrhosis in 2 years.3,4 Early intervention can prevent fibrosis progression and induce regression.

    Based on references 3–6.

  • Stepwise screening approach to identify patients at risk of metabolic dysfunction–associated steatohepatitis (MASH) with advanced liver fibrosis. This algorithm may also be used in cases of incidentally detected steatosis.aFibrosis-4 calculator is embedded in some electronic medical record systems and is also available online (www.mdcalc.com/calc/2200/fibrosis-4-fib-4-index-liver-fibrosis).bA higher cutoff (> 2.0) should be used for adults older than 65.cIf vibration-controlled transient elastography is unavailable, alternate tests include magnetic resonance elastography and the Enhanced Liver Fibrosis test.Based on references 1 and 14.
    Figure 2

    Stepwise screening approach to identify patients at risk of metabolic dysfunction–associated steatohepatitis (MASH) with advanced liver fibrosis. This algorithm may also be used in cases of incidentally detected steatosis.

    aFibrosis-4 calculator is embedded in some electronic medical record systems and is also available online (www.mdcalc.com/calc/2200/fibrosis-4-fib-4-index-liver-fibrosis).

    bA higher cutoff (> 2.0) should be used for adults older than 65.

    cIf vibration-controlled transient elastography is unavailable, alternate tests include magnetic resonance elastography and the Enhanced Liver Fibrosis test.

    Based on references 1 and 14.

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